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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603431
Report Date: 12/16/2024
Date Signed: 12/16/2024 01:07:25 PM

Document Has Been Signed on 12/16/2024 01:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ACTIVCARE AT ROLLING HILLS RANCHFACILITY NUMBER:
374603431
ADMINISTRATOR/
DIRECTOR:		BONGHABIH N. SHEYFACILITY TYPE:
740
ADDRESS:850 DUNCAN RANCH ROADTELEPHONE:
(619) 482-8000
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 50DATE:
12/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Executive Director Bonghabih SmithTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted a case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Business Manager Alondra .

A Change of Capacity application was received by the Department on 8/9/24, in which the licensee requested capacity to be increased. The Fire Safety Inspection Request was approved by the local fire authority on 9/20/24.

During today’s visit, LPA toured the facility and inspected requested double occupancy bedrooms. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed during today's visit.

The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with Smith, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
Robyn ClarkTELEPHONE: (619) 767-2312
Alyssa RamirezTELEPHONE: 619-767-2301
DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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